超声消融Ⅱ型黏膜下子宫肌瘤治疗焦点安全距离的研究  

Study on focal distance of H type uterine fibroids under mucous membrane treated by high intensity focused ultrasound ablation

作　　者：张汝坚[1] 陈向东[1] 冯敏清[1] 陈莉婷[1] 王浩[1] 

机构地区：[1]佛山市妇幼保健院妇科,广东省佛山528000

出　　处：《中国基层医药》2016年第12期1835-1840,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨高强度聚焦（HIFU）消融不同治疗焦点至子宫内膜最近距离与子宫内膜损伤的关系。方法选取行 HIFU 消融术的无生育要求的Ⅱ型黏膜下子宫肌瘤患者150例。将所有患者按黏膜下肌瘤的位置分为前壁、后壁两组，每组再随机分为治疗 A 组、B 组及 C 组，各组均为25例，A、B、C 组焦点分别距离子宫内膜15 mm、18 mm 和20 mm，均采用 HIFU 消融治疗，患者症状改善采用子宫肌瘤症状量表（UFS）评定，治疗总能量采用能效因子（EEF）表示，术后第2天 MRI 测量子宫肌瘤坏死边缘至内膜的最近距离和肌瘤消融率、子宫内膜完整性和阴道流血情况（采用月经评分表），术后3个月复查子宫内膜完整性和阴道流血情况。结果HIFU 消融治疗后，患者症状均有明显改善，且前壁患者症状改善明显优于后壁肌瘤患者（t ＝3．868，P ＝0．01）。对于前壁肌瘤，B 组和 C 组效果最明显（F ＝4．711，P ＜0．05），但对于后壁肌瘤，焦点距离与症状改善差异无统计学意义（F ＝3．898，P ＞0．05）。HIFU 消融对于前壁肌瘤消融率明显高于后壁肌瘤患者（t ＝9．818，P ＜0．01），后壁肌瘤所需的能量明显高于前壁（t ＝11．224，P ＜0．01）。对于前壁肌瘤，A 组的消融率最高（F ＝105．673，P ＜0．01），其次为 B 组，最差为 C 组，对于后壁肌瘤，消融率与焦点距离无显著相关性（F ＝0．485，P ＞0．05）。术后第2天，前壁肌瘤患者子宫内膜完整率为93．33％，显著高于后壁肌瘤患者77．33％，子宫内膜完整性在前壁与后壁肌瘤患者总体分布差异有统计学意义（χ2＝7．67，P ＜0．05），而术后3个月，前壁肌瘤患者子宫内膜完整率为94．67％，显著高于后壁肌瘤患者82．67％。术后第2天，对于前壁肌瘤，B 组与 C 组的子宫内膜完整率均可达100．00％，均高于距离为 A 组的完整率（80．00Objective To assess the relationship between endometrium damage and focal distance of high intensity focused ultrasound ablation（HIFU）.Methods 150 patients with requirement of atoke from Ⅱ type uterine fibroids under HIFU were collected and divided into two groups by the location of fibroids,one was antetheca group, and the other was posterior group,which were further divided into three groups,A group（25 cases）,B group（25 cases）, and C group（25 cases）,in which their distance were 15mm,18mm,and 20mm from endometrium respectively.Those patients were treated with HIFU,and improvement of symptoms was assessed by uterine fibroids symptom （UFS） score,energy efficiency factor（EEF）was served as total energy required by treatment,the closest distance from margin of necrosis of fibroids to endometrium and the rate of ablation were detected by MRI,as well as integrity of endo-metrium and vaginal bleeding were observed on postoperative 2 days and 3 months.Results After treatment by HIFU,significant improvement of symptoms was found,especially for the fibroids in antetheca（t =3.868,P =0.01）, moreover,as for the fibroids in antetheca,the obvious efficacy was found in B group and C group（F =4.711,P 〈0.05）,while for posterior fibroids,the efficacy was not associated with the location of HIFU（F =3.898,P 〉0.05）.In addition,high rate of ablation and low EEF for the fibroids in antetheca was found（t =9.818,11.224,respectively,all P 〈0.01）,and the highest rate of ablation in A group was revealed（F =105.673,P 〈0.01）,followed by that of B group,the worse was C group.While in posterior fibroids,the distance was not associated with the rate of ablation（F =0.485,P 〉0.05）.There was significant difference of integrity rate for endometrium between antetheca and posterior fibroids on postoperative 2 days（93.33% vs.77.33%,χ^2 =7.67,P 〈0.05）,and the rate in antetheca fibroids was higher than that of posterior fibroids（94.67% vs.82.67%）on postoperative 3 months.After postoper

关 键 词：平滑肌瘤 子宫肌层 高强度聚焦超声消融 治疗应用 

分 类 号：R737.33[医药卫生—肿瘤]